When should we place a Midline instead of a PICC line? Midlines are lines that are 20cm in length, the tip terminates in the upper arm and can remain in for about 10 days. The patients that benefit the most from Midlines are those that we call “difficult sticks”, they can have diagnosis of dehydration, COPD, CHF and short term IV abx needs. This line is placed by PICC trained nurses, but can be taught to all nurses. Care and maintenance is the same as a PICC line, but the big difference is the tip is not central and the patient is at less risk for CR-BSI’s (catheter related blood stream infections). When assessing the patient for the best line for their therapy and needs, we should also consider this line. It takes less time to insert, complications are less, and it prevents multiple needle sticks in the patient with difficult access.
Midline Catheters are indicated for many patients. They come in 10 and 20cm lengths. This device can be used for the patient with COPD, CHF, Dehydration, some Cellulitis diagnosis and the "difficult stick" patient. If the ph is between 5 and 9 and the length of therapy is under 30 days, we need to consider this device. We need to be placing the line on admission. One line for their entire length to stay. When we hear that the patient has been "stuck" several times, this line immediately comes to mind.